| NPI | 1538576871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: SD CP000873) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: SD 00896893) |
| Enumeration Date | 2014-07-18 |
| Last Update Date | 2021-02-14 |